46D1090969 CLIA NUMBER - SMITHS PHARMACY #136

Laboratory Demographics

  • CLIA Code: 46D1090969
  • Facility Name: SMITHS PHARMACY #136
  • Facility Address: 350 N FREEDOM
    PROVO, UT
    ZIP 84601
  • Facility Phone: 801 377-9250
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAIME MONTUORO
  • NPI Number: 1760407399
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D1090969
LAB Type Pharmacy
Facility Name SMITHS PHARMACY #136
Street 350 N FREEDOM
City PROVO
State UT
ZIP 84601
Phone 801 377-9250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2024
Certificate Expiration Date 10/21/2026
Facility Type Pharmacy
Lab Director JAIME MONTUORO

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This page was last updated on: 9/29/2025